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Updated: Jul 14, 2025
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Preoperative echocardiography in patients with hip fracture: a prospective cohort study
Carlo Rostagno1, Camilla Tozzetti1
1Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy.
Insights
Preoperative echocardiography in high-risk hip fracture patients did not delay surgery or hospital stay. This cardiac assessment may optimize care without impacting surgical timing, benefiting patient outcomes.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Geriatric Medicine
Background:
- Clinical guidelines recommend preoperative echocardiography for hip fracture patients.
- Prospective studies evaluating its impact on surgical outcomes are lacking.
Purpose of the Study:
- To assess the effect of preoperative echocardiography on time to surgery, length of hospital stay (LOS), and in-hospital mortality in high-risk hip fracture patients.
Main Methods:
- A prospective study included 255 hip fracture patients; 122 underwent echocardiography.
- Echocardiography was performed in high-risk patients (systolic murmurs, unstable conditions, heart failure, coronary disease).
- Outcomes were compared between echocardiography (high-risk) and no-echocardiography (low-risk) groups, and a historical control group (717 patients).
Main Results:
- Echocardiography group had higher rates of coronary heart disease, atrial fibrillation, and comorbidities.
- Time to surgery and LOS were similar between echocardiography and no-echocardiography groups.
- In-hospital mortality was not significantly different between groups (1.9% vs 1.7%) but was lower than the control group (4.1%).
Conclusions:
- Preoperative echocardiography in high-risk hip fracture patients did not delay surgery or increase LOS.
- Echocardiography can guide anesthetic choices, post-operative care, and medical treatment without compromising surgical timing.
- This approach may optimize management for high-risk hip fracture patients.
Introduction:
Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the present investigation was to assess whether preoperative echocardiography affects time to surgery, length of hospital stay (LOS), and in hospital mortality in high-risk patients who need surgery for a hip fracture.
Material And Methods:
In the study entered 255 consecutive patients with hip fracture referred to a multidisciplinary hip fracture unit. Seven hundred seventeen patients referred before the implementation of routine echocardiographic examination were considered as control group. Echocardiography was performed in patients with systolic murmurs, unstable clinical conditions, recent decompensation of heart failure or hospital admission for coronary disease. Time to surgery, LOS, and in hospital mortality in patients who underwent preoperative echocardiography (high-risk group) were compared with patients who did not undergo echo (low-risk group) and with the control group.
Results:
122/255 patients underwent echocardiography. The two groups did not differ for age, sex, type or fracture, and notably time to surgery and LOS. Coronary heart disease, atrial fibrillation, and two or more comorbidities were more frequent in the echo group. Overall clinical characteristics were not different from group of patients referred before the implementation of the echocardiographic protocol but in these last patients time to surgery and LOS were significantly longer. As well in hospital mortality was not significantly different in the two groups (1.9 in echo vs. 1.7% in nonecho) but lower than in the control group (4.1% ).
Conclusions:
An echocardiographic guide may be useful in a high-risk group with a hip fracture to choose the proper anesthetic setting, referral for intensive care observation after surgery and, optimal medical treatment, including fluid management without delay in time to surgery.
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